Predictive factors for bactibilia in acute cholecystitis

Area of Science:

• Gastroenterology
• Surgical Infections
• Clinical Microbiology

Background:

• Acute cholecystitis is a significant risk factor for bacterial infection in the bile and surgical site infections.
• However, not all patients with acute cholecystitis present with bacterial presence in the bile.

Purpose of the Study:

• To identify clinical and laboratory parameters that predict the presence of bacteria in the bile (bactibilia) in patients with acute cholecystitis.
• To stratify patients based on predictive factors to guide preoperative antibiotic strategies.

Main Methods:

• Analysis of 20 clinical and laboratory parameters in 49 patients diagnosed with acute cholecystitis.
• Univariate and multifactorial analyses were employed to identify significant predictors of bactibilia.
• Bile and/or gallbladder wall cultures were used to confirm the presence of bacteria.

Main Results:

• Bactibilia was confirmed in 42.9% of the patients.
• Preoperative temperature > 37.3°C, total serum bilirubin > 8.6 μmol/L, and white blood cell count > 14.1 x 10^9/L were identified as significant predictors.
• Patients with zero or one predictive factor had a significantly lower incidence of bactibilia (6%) compared to those with two or three factors (63%).

Conclusions:

• The preoperative culture status of patients with acute cholecystitis can be predicted using specific clinical and laboratory parameters.
• A single preoperative antibiotic dose is proposed for patients with zero or one predictive factor.
• Patients with two or three predictive factors warrant continued antibiotic therapy until culture data are available to guide treatment.